What question did this study set out to answer?

To determine whether standard basal echocardiographic metrics fail to capture significant left ventricular (LV) remodeling before and after surgery in patients with isolated mitral regurgitation (MR).

April 11, 2012CirculationOpen Access

Magnetic Resonance Imaging With 3-Dimensional Analysis of Left Ventricular Remodeling in Isolated Mitral Regurgitation

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Degenerative isolated mitral regurgitation (n=145). Intervention: Cine magnetic resonance imaging and mitral valve repair vs. Healthy controls and preoperative baseline. Primary outcome: Left ventricular ejection fraction (p=<0.0001).

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Key result

In patients with isolated mitral regurgitation, 3D MRI showed significant spherical left ventricular remodeling, and LVEF decreased from 61% to 54% at 1 year after mitral valve repair (P<0.0001).

Why the study?

Does 3-dimensional magnetic resonance imaging better detect left ventricular remodeling compared to standard geometry-based calculations in patients with isolated mitral regurgitation?

Key Points

To determine whether standard basal echocardiographic metrics fail to capture significant left ventricular (LV) remodeling before and after surgery in patients with isolated mitral regurgitation (MR).
Evaluated 94 patients with degenerative isolated MR (mean age 54 ± 11 years; 38% female) and 51 control subjects (mean age 44 ± 14 years; 53% female) using cine magnetic resonance imaging (MRI) with tissue tagging and 3D analysis.
Tracked 35 patients who underwent mitral valve repair per guideline criteria and assessed postoperative LV geometry and function at 1 year.
In MR patients, the relation between LV end-systolic volume (LVESV) and LV end-systolic dimension followed a cubic curve rather than the quadratic curve seen in controls, with actual MRI-derived LVESV significantly higher than calculations using the Bullet formula due to distal spherical remodeling (P<0.001).
Following mitral valve repair in 35 patients, LV ejection fraction declined from 61 ± 7% to 54 ± 8% (P<0.0001) and maximum myocardial shortening fell significantly below normal at 1-year follow-up (P<0.0001).
Despite normalization of LV stroke volume and end-diastolic volume/mass ratio postoperatively, persistent increases in the distal LVES 3D radius/wall thickness ratio and LVESV index remained.

Study Design

Type

Observational (n=145)

Structured PICO

Does 3-dimensional magnetic resonance imaging better detect left ventricular remodeling compared to standard geometry-based calculations in patients with isolated mitral regurgitation?

Population

94 patients with degenerative isolated mitral regurgitation (mean age 54 ± 11 years, 38% female) and 51 control subjects (mean age 44 ± 14 years, 53% female).

Intervention

Cine magnetic resonance imaging with tissue tagging and 3-dimensional analysis.

Comparator

Standard geometry-based calculations (Bullet formula) and healthy control subjects.

Outcome

Left ventricular end-systolic volume (LVESV) and the relationship between LVESV and LVES dimension.surrogate

Main Result

Absolute Event Rate: 54% vs 61%

p-value: p=<0.0001

3D MRI reveals significant spherical mid-to-apical LV remodeling in isolated mitral regurgitation that is missed by standard geometric calculations, suggesting volumetric analysis is superior for tracking disease progression.

Discussion

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Implication

3D MRI may improve detection of post-repair LV remodeling missed by standard measures; leaves open whether volumetric monitoring should guide practice.

Cite This Study

Schiros et al. (2012) conducted an observational in Degenerative isolated mitral regurgitation (n=145). Cine magnetic resonance imaging and mitral valve repair vs. Healthy controls and preoperative baseline was evaluated on Left ventricular ejection fraction (p=<0.0001). In patients with isolated mitral regurgitation, 3D MRI showed significant spherical left ventricular remodeling, and LVEF decreased from 61% to 54% at 1 year after mitral valve repair (P<0.0001).

synapsesocial.com/papers/6a0fde1ed13714ec96feb911 https://doi.org/10.1161/circulationaha.111.073239

Topics

Mitral valve intervention

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Implication

3D MRI may improve detection of post-repair LV remodeling missed by standard measures; leaves open whether volumetric monitoring should guide practice.

Magnetic Resonance Imaging With 3-Dimensional Analysis of Left Ventricular Remodeling in Isolated Mitral Regurgitation

Key Points

Study Design

Structured PICO

Main Result

Discussion

Implication

Cite This Study

Topics

Magnetic Resonance Imaging With 3-Dimensional Analysis of Left Ventricular Remodeling in Isolated Mitral Regurgitation

Key Points

Study Design

Structured PICO

Main Result

Discussion

Implication

Cite This Study

Also Consider

Topics

Also Consider